Elsevier

Women's Health Issues

Volume 15, Issue 3, May–June 2005, Pages 109-116
Women's Health Issues

Doulas as childbirth paraprofessionals: Results from a national survey

https://doi.org/10.1016/j.whi.2005.01.002Get rights and content

Fourteen randomized trials have demonstrated that continuous caregiver support during childbirth can lead to shorter labors and decrease the need for intervention. In response, there has been a significant increase in the number and use of doulas as paraprofessionals who provide social and emotional support to women during labor/birth for a fee. We conducted a mailed survey of a nationally representative sample of certified and certification-in-process doulas in the United States (n = 626, 64.4% response rate) to gather some descriptive information on their sociodemographic backgrounds, practice characteristics, and beliefs/attitudes on a number of salient issues. The survey results suggest that, in 2003, doulas were primarily white, well-educated married women with children. The majority of certified doulas worked in solo practice and provided childbirth support services on average to nine clients per year. Very few doulas were earning more than $5,000 per year from this work, and only 10% of certified doulas reported receiving third-party reimbursement for their services. Thus, while almost all doulas found their work emotionally satisfying, only one in three saw their work as financially rewarding. Doulas also reported challenges in getting support/respect from clinicians and in balancing doula work and family life. In addition, one in four doulas reported that they were preparing for a career in midwifery. Doulas can play an important and unique role in the childbirth process and reap many personal rewards engaging in this type of work. However, a number of financial, personal, and professional challenges present significant obstacles to the growth of doulas as childbirth paraprofessionals in the United States.

Section snippets

Background

One of the many changes in childbirth in the United States during the 20th century was a decline in the presence of family members or friends providing support to a woman during labor and birth (Leavitt, 1999; van Teijlingen et al., 2000). Over the past two decades, however, there has been renewed interest in the use of “supportive caregivers” during childbirth (Hodnett et al., 2003; Klaus & Kennell, 1997). A critical component of “supportive care” is providing continuous support during the

Methods

This study was a cross-sectional survey of doulas in the United States and was approved by the Health Sciences Institutional Review Board at the University of Michigan. The study population included all doulas listed as certified or as having started but not yet completed certification by five professional doula associations: 1) Association of Labor Assistants and Childbirth Educators (ALACE); 2) Birth Works; 3) Childbirth and Postpartum Professional Association (CAPPA); 4) Doulas of North

Results

This sample of doulas is comprised of 471 (75.2%) certified and 155 (24.8%) yet-to-be certified doulas. The majority of doulas reported their ethnicity as white (93.8%), and respondents ranged in age from 20 to 71, with a mean age of 40.3 years. In addition, the majority of doulas were married (81.6%) and had given birth themselves (87.8%). Compared to certified doulas, not-yet-certified doulas were significantly younger, less likely to be white, and less likely to be married or have given

Discussion

It is difficult to estimate the number of doulas in practice in the United States. What is clear, however, is that the number of people who are seeking certification and who are offering doula services for a fee or as part of a hospital-based maternity care team is growing (Meyer, Arnold & Pascali-Bonaro, 2001; Morton, 2002). This article presents some basic descriptive information gathered from a national sample of doulas working as paraprofessionals in the United States in 2003. The results

Acknowledgements

This research was funded in part by a grant from the Walter McNerney Fund at the University of Michigan. Gratitude is extended to the organizations that provided mailing lists for the survey sample: Association of Labor Assistants and Childbirth Educators, Birth Works, Childbirth and Postpartum Professional Association, Doulas of North America, and International Childbirth Educators Association. In addition, appreciation is extended to all of the doulas and labor assistants who participated in

Paula M. Lantz, Associate Professor of Health Management and Policy at the University of Michigan School of Public Health, conducts policy-focused research on women’s health services and social inequalities in health.

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    Paula M. Lantz, Associate Professor of Health Management and Policy at the University of Michigan School of Public Health, conducts policy-focused research on women’s health services and social inequalities in health.

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